The human mind is not isolated; it is a dynamic relational subject animating the society in which it lives. Heidegger named this Mitsein, a state of “being-with” that is the foundation of human experience. We are an ultra-social species, “obligatorily gregarious” (de Waal Reference de Waal2006, p. 4).

Jaswal & Akhtar (J&A) present an impressive array of evidence that individuals with autism retain a fundamental drive for social interaction and meaningful social relations. Mitsein in autism is intact, although its means of expression and social interaction are characteristically different. Recent research on the neuroscience of the human social brain, and affective “moral” regulation of acts of social engagement, changes the theory of disorders of relating, including in schizophrenia and autism (Damasio et al. Reference Damasio, Damasio and Tranel2013; Nieuwenhuys Reference Nieuwenhuys2012)

In our work, we have examined the embodied nature of human social interaction in ontogenesis, measuring its origins in expressive intentions of the infant's subjective self (Delafield-Butt & Gangopadhyay Reference Delafield-Butt and Gangopadhyay2013; Delafield-Butt et al. Reference Delafield-Butt, Freer, Perkins, Skulina, Schögler and Lee2018), made in relation to the movements of another (Delafield-Butt & Trevarthen Reference Delafield-Butt and Trevarthen2015; Trevarthen & Delafield-Butt Reference Trevarthen, Delafield-Butt, White and Dalli2017b) that can be affected and contribute to pathology (Trevarthen et al. Reference Trevarthen, Aitken, Vandekerckhove, Delafield-Butt, Nagy, Cicchetti and Cohen2006). Feelings and desires expressed though a reciprocal coherence of felt action co-create social meaning (Delafield-Butt & Trevarthen Reference Delafield-Butt and Trevarthen2015; Trevarthen & Delafield-Butt Reference Trevarthen, Delafield-Butt, Legerstee, Haley and Bornstein2013b). After 9 months, an infant's acts of selective attention combine interests in objects and other persons (Aitken & Trevarthen Reference Aitken and Trevarthen1997; Hubley & Trevarthen Reference Hubley, Trevarthen and Uzgiris1979), which shape the learning of values of a culture (Trevarthen Reference Trevarthen2009; Trevarthen & Delafield-Butt Reference Trevarthen, Delafield-Butt, Hopkins, Geangu and Linkenauger2017a).

In autism, we identify a fundamental disruption of the intuitive prospective motor control and its affective regulation in “vitality dynamics” (Fournier et al. Reference Fournier, Hass, Naik, Lodha and Cauraugh2010; Stern Reference Stern2010). There is an alteration in the subsecond kinematic patterns of intentional movement of the arms and hands (Trevarthen & Delafield-Butt Reference Trevarthen and Delafield-Butt2013a), whether to swing the arms, reach to touch, swipe a tablet, or write a name (Anzulewicz et al. Reference Anzulewicz, Sobota and Delafield-Butt2016; Cook et al. Reference Cook, Blakemore and Press2013; Dowd et al. Reference Dowd, McGinley, Taffe and Rinehart2012; Grace et al. Reference Grace, Johnson, Rinehart and Enticott2018; Torres et al. Reference Torres, Brincker, Isenhower, Yanovich, Stigler, Nurnberger, Metaxas and Jose2013).

Precise timing is required for efficient, purposeful movement and for effective expressive gesture in dialogue (Trevarthen et al. Reference Trevarthen, Delafield-Butt, Schögler, Gritten and King2011). Child psychiatrist Daniel Stern called the affective nature of the action pattern “vitality affects” (Stern Reference Stern2010), meaning autonomic regulations expressed in movements shaped to convey visceral states of feeling (Damasio Reference Damasio1999; Porges Reference Porges2011). The evidence shows that these actions are timed differently in autism and that perception of others’ vitality affects is weakened (Di Cesare et al. Reference Di Cesare, Sparaci, Pelosi, Mazzone, Giovagnoli, Menghini, Ruffaldi and Vicari2017; Rochat et al. Reference Rochat, Veroni, Bruschweiler-Stern, Pieraccini, Bonnet-Brilhault, Barthelemy, Malvy, Sinigaglia, Stern and Rizzolatti2013). This perturbation of human communication and affectionate social engagement (Trevarthen & Delafield-Butt Reference Trevarthen and Delafield-Butt2013a) is expressed as autistic aloneness and self-protective isolation (St. Clair et al. Reference St. Clair, Danon-Boileau, Trevarthen and Acquarone2007), which can be misread as absence of sociability by persons with whom an autistic child is seeking meaningful engagement and shared learning (Cook Reference Cook2016; De Jaegher Reference De Jaegher2013; Trevarthen & Delafield-Butt Reference Trevarthen and Delafield-Butt2013a).

A similar break in the reciprocal dynamic of the dyad is found in congenital Moebius syndrome that disrupts or paralyses facial expression, interrupting affective resonance. Moebius is associated with a high incidence of autism (Gillberg & Steffenburg Reference Gillberg and Steffenburg1989). Other neurodevelopmental motor disorders, such as deficits in attention, motor control and perception (DAMP) and developmental coordination disorder (DCD), have autistic features. “Motor clumsiness” and autism overlap (Gillberg Reference Gillberg1983; Reference Gillberg2003; Gillberg & Kadesjö Reference Gillberg and Kadesjö2003).

A likely site of the origins of this autism motor disturbance is in brainstem sensory and motor integrative systems that are closely coupled to those responsible for affective evaluation and social motor expression, together with closely coupled cerebellar structures (Coleman & Gillberg Reference Coleman and Gillberg2012; Fatemi et al. Reference Fatemi, Aldinger, Ashwood, Bauman, Blaha, Blatt, Chauhan, Chauhan, Dager, Dickson, Estes, Goldowitz, Heck, Kemper, King, Martin, Millen, Mittleman, Mosconi, Persico, Sweeney, Webb and Welsh2012; Porges Reference Porges2011; Trevarthen & Delafield-Butt Reference Trevarthen and Delafield-Butt2013a). Moebius syndrome follows a developmental error of the cranial nerves, and movement disturbance indicative of a brainstem growth error is evident in autism at birth (Teitelbaum et al. Reference Teitelbaum, Teitelbaum, Nye, Fryman and Maurer1998), and in preschool children with autism (Bosco et al. Reference Bosco, Giuliano, Delafield-Butt, Muratori, Calderoni and Retico2019). Volumetric differences persist across the life span (Haar et al. Reference Haar, Berman, Behrmann and Dinstein2014). Brainstem disruption affects one's core integration of psycho-motor experience, called the “primary self” (Panksepp & Biven Reference Panksepp and Biven2012). It is not the wish for social engagement that is disrupted, but the coherence of primary sensory and motor information that make up the “core self” expressed through body movement (Delafield-Butt & Trevarthen Reference Delafield-Butt, Trevarthen, Torres and Whyatt2017).

The new theory of the social brain gives importance to the forebrain systems centered on the insula, which develop as regulators of motor expressions of vital state and engagement of social affordances. Affective and social neuroscience is undergoing a change with the recognition of the complexity of internal, basic proprioceptive, and visceroreceptive evaluations of plans for action for the embodied self (Merker Reference Merker2007; Vandekerckhove & Panksepp Reference Vandekerckhove and Panksepp2011), and for cooperative action in affectionate relations regulated by intersubjective sensitivity for these intrinsic parameters of consciousness with feeling (Schilbach et al. Reference Schilbach, Timmermans, Reddy, Costall, Bente, Schlicht and Vogeley2013). This approach supports transformations of psychological theory, with reduced dependence on linguistic communication and more appreciation of social meaning in embodied, non-verbal expression with vitality dynamics to make meaningful contact. It supports an enhanced appreciation of shared awareness in the present moment of what Damasio (Reference Damasio2011) calls complex social emotional experiences, such as embarrassment, shame, guilt, contempt, compassion, and admiration. These will be complicated by abnormalities of motor coordination and timing that develop with autism.

Infants, like adults, avert eye gaze in interactions that are felt to be too intense, a normal self-regulation (Jaffe et al. Reference Jaffe, Beebe, Feldstein, Crown and Jasnow2001). However, with autistics, this behaviour may be appreciated differently. It is considered asocial in literate, industrial cultures, which expect “conversational partners to respond promptly and to make their contributions to conversations unambiguous and relevant” (J&A, sect. 2, para. 1, citing Grice Reference Grice, Cole and Morgan1975). Conventions of motor expression in polite adult dialogues can affect the way autistic avoidance is received and cared for, and these conventions will influence the choice of therapy.

We are led by this thoughtful review to a re-evaluation of human understanding of how a child's well-being flourishes and develops. Meaningful social relations require sensitive appreciation and forms of response that respect all forms of expression and seek to share experiences (Sullivan & Rees Reference Sullivan and Rees2008). When this is achieved, understanding and satisfaction in relationships can flourish.